MEDICARE: MELINDA ANNA DIXON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301047429	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11563449	OTHER	MI	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730192410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA ANNA DIXON MD

Provider Business Mailing Address
First Line	:	18464 SALEM
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219
Country	:	US
Telephone Number	:	313-533-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 TAYLOR STREET
Second Line	:	DETROIT HEALTH DEPT HERMAN KIEFER HEALTH COMPLEX
City	:	DETROIT
State	:	MI
Zip	:	48202-1732
Country	:	US
Telephone Number	:	313-876-4720
Fax Number	:	313-876-0070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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